The use of computer systems to process health care transactions is widespread. This is the problem. Each generator of health care transactions stores information particular to its needs in a database format optimized for its processes in a computer environment developed from its technical skill level, growth and history.
For example, hospitals store a wealth of information on each patient, health care provider and medical intervention occurring within its walls. Hospitals store information such as, for example, in-patient and out-patient records (including patient charts), doctor privileges, nurse care schedules, operating room schedules and equipment inventories. Traditionally, hospitals transmit only as much of this information to health care insurers as needed to be reimbursed for health care costs.
In another example, physician offices also keep electronic records on each patient. Such information may include patient's personal data, patient immunization records, patient health history records and details about each patient visit. Again, health care providers typically transmit only as much of this information to health care insurers as needed to be reimbursed for health care costs.
In another example, dental offices also keep electronic records on each patient. Such information may include patient's personal data, patient dental cleaning history, records of upcoming appointments, patient health history records and details about each patient visit. Again, dental care providers typically transmit only as much of this information to health care insurers as needed to be reimbursed for dental care costs.
In yet another example, pharmacies keep electronic records concerning patient prescriptions, patient allergies and patient personal data. Again, pharmacies typically transmit only as much of this information to health care insurers as needed to be reimbursed for pharmacy costs.
The information requesting reimbursement for health care provided to a patient typically is transferred to the health care insurer in the form of a claim. The exact format of a claim takes many different electronic forms depending on the entity that generates the claim. A health care provider entity may be, for example, a hospital, physician office, dentist office or pharmacy. In addition, some claims pass through third party claims clearinghouses before being accepted by the health care insurer which may further change their electronic format. Payment obligations may pass to claims clearinghouses, other insurers, or a financial institution.
The data transfer itself may occur through very different transfer protocols and data error detection processes resulting in transforming data into even different formats.
The difficulty of communicating among different types of information stored in different electronic structures in different electronic environments is compounded when that information may be encrypted and/or compressed as well using different encryption and compression schemes.
In addition, the information itself may be stored in different human languages. Claims generating from a hospital in France are written in French in addition to the French data being encoded in a different database format in a different computer environment. For example, the common format for recording a date in the United States is month/day/year but in Europe, the common format is day.cndot.month.cndot.year. Though a perhaps minor difference, the erroneous transposition of the month and day in a data format would seriously undermine the integrity of all the records of an entire file.
There is a continued need for a system capable of communicating between a multiplicity of different computer environments.